Insurance/Preauthorization Specialist
1 week ago
Job Details
Description
Mountain View Hospital is looking for a Insurance/Preauthorization Specialist to join our team
JOB SUMMARY:
Checks appointments and tasks/messages to make sure the diagnosis/documentation will support medical necessity, as per insurance company, and verify that all office visits and procedures that need preauthorization are pre-authorized. Works closely with referring offices to be used as a resource in helping them get necessary paperwork to start pre-authorizations, prove medical necessity, or to perform a retro-authorization. Works closely with co-workers and vendor representatives to get visits/procedures approved.
BENEFITS:
Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:
Medical, Dental and Vision Insurance Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off Retirement Plans (401K with up to 6% match) Earned Quarterly Bonus Program Education Reimbursement Program Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community HospitalPlease note benefits are based on eligibility according to full-time, part-time or PRN status classification.
DUTIES AND RESPONSIBILITIES:
1. In a professional and friendly manner, answers incoming phone calls transferred to preauthorization department, answers preauthorization questions from patients, co-workers and providers.
2. Secures physician orders and uses all patient information for charting, billing and record keeping purposes.
3. Accurately, and in a timely manner, processes requests for office visits and procedures to be sent from other facilities and physician’s offices.
4. Verifies all patients have appropriate diagnosis for each exam to support medical necessity according to LCD’s and payer policies, when submitting
prior authorization requests.
5. Works closely and professionally with referring providers when an emergency procedure needs to be done and/or is denied reimbursement to help the provider get all paperwork in order to start the authorization process, prove medical necessity, and/or retro-authorization.
6. Works directly with Billing Office in denials.
7. Maintains flexibility as department grows with willingness to accept additional responsibilities requested by department manager/supervisor/director.
8. Acts professional in every situation: patient, co-worker or intradepartmental.
9. Recognizes that many people we see are at a low point in their lives and will show compassion for them even if it is only a smile.
10. Protects information that is sensitive, proprietary or confidential in nature. Adheres to Patient Rights Policy and patient confidentiality standards.
11. Works to provide functional and safe surroundings for patients and staff (, safety, security, infection control, etc.). Strives to always promote personal
and patient safety. Demonstrates awareness of the location of applicable hospital and department specific manuals.
12. Completes all annual mandatory education requirements (including hospital, department, and job specific competencies).
13. Attends the required number of staff meetings per department standard.
14. Arrives at work station and is ready to work at the designated start time.
15. Is willing to do assignments, cross-training, or tasks within the scope of his/her job description, as asked by the manager, which are deemed necessary to meet the needs of the department.
16. Maintains adaptability. Adapts to change in a positive and professional manner. Accepts responsibility for his/her actions, attitudes and mistakes without placing blame.
17. Is accountable for completing all assigned responsibilities/tasks and takes action when opportunities to improve are identified.
18. Promotes effective working relationship and works effectively as a part of the department/team to facilitate the hospital and department’s ability to meet its goals and objectives.
ABOUT MOUNTAIN VIEW:
Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.
Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.
Qualifications
Education: High School graduate or equivalent. Knowledge of diagnoses and CPT codes for pain management services preferred.
Experience: Prior experience with coding and billing for outpatient billing is preferred.
Language/Communication: Ability to communicate well with patients, co-workers and vendor representatives.
Mental Capabilities: Continuously able to concentrate on fine detail with interruptions and continuously able to attend to task/function for an extended period of time. Ability to learn computer programs and input data as required.
Interpersonal: Ability to work well with others.
Performance: Writing skills necessary to properly submit preauthorization requests with insurance companies. Appropriate phone etiquette to properly submit
preauthorization requests with insurance companies. Holds the judgment, tact and diplomacy to effectively resolve conflicts.
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